Synthetic cannabinoid overdose in a 20-year-old male US soldier.

Popularity of synthetic cannabinoids among US military service members has risen over the last several years, leading to an increase in hospitalizations and legal actions stemming from its use and possession. Although synthetic cannabinoids, collectively referred to as "Spice," are similar in structure to the active metabolites found in cannabis, significant concerns exist regarding the severity of short- and long-term medical and psychiatric sequelae. This article presents a case, in which a patient experienced severe medical and psychiatric symptoms far exceeding the severity and duration typically resulting from cannabis use.

Quantum manipulation via atomic-scale magnetoelectric effects.

Magnetoelectric effects at the atomic scale are demonstrated to afford unique functionality. This is shown explicitly for a quantum corral defined by a wall of magnetic atoms on a metal surface where spin-orbit coupling is observable. We show these magnetoelectric effects allow one to control the properties of systems placed inside the corral as well as their electronic signatures; they provide powerful alternative tools for probing electronic properties at the atomic scale.

Glomerular Disease in Temporal Association with SARS-CoV-2 Vaccination: A Series of 29 Cases.

Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several patient reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated GN, collapsing glomerulopathy, or diffuse lupus nephritis diagnosed on kidney biopsies postimmunization, as well as recurrent ANCA-associated GN. This included 28 cases of de novo GN within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of Black descent and had two APOL1 genomic risk alleles. A brief literature review of patient reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown; however, there was no overall increase in incidence of glomerular disease when compared with the 2 years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: Glomerular disease to vaccination is rare, although it should be monitored as a potential adverse event.

The performance of in situ grown Schottky-barrier single wall carbon nanotube field-effect transistors.

Electrical transport measurements were used to study device behavior that results from the interplay of defects and inadvertent contact variance that develops in as-grown semiconducting single wall carbon nanotube devices with nominally identical Au contacts. The transport measurements reveal that as-grown nanotubes contain defects that limit the performance of field-effect transistors with ohmic contacts. In Schottky-barrier field-effect transistors the device performance is dominated by the Schottky barrier and the nanotube defects have little effect. We also observed strong rectifying behavior attributed to extreme contact asymmetry due to the different nanoscale roughness of the gold contacts formed during nanotube growth.

Transport and strong-correlation phenomena in carbon nanotube quantum dots in a magnetic field.

Transport through carbon nanotube (CNT) quantum dots (QDs) in a magnetic field is discussed. The evolution of the system from the ultraviolet to the infrared is analyzed; the strongly correlated (SC) states arising in the infrared are investigated. Experimental consequences of the physics are presented-the SC states arising at various fillings are shown to be drastically different, with distinct signatures in the conductance and, in particular, the noise. Besides CNT QDs, our results are also relevant to double-QD systems.

Effect of Stellate Ganglion Block on Specific Symptom Clusters for Treatment of Post-Traumatic Stress Disorder.

This study assessed which symptoms are most impacted following stellate ganglion block (SGB) used to treat post-traumatic stress disorder (PTSD) symptoms. 30 active military service members with combat-related PTSD self-referred to their physician and psychologist. Patients were offered a SGB as part of their treatment program. Primary outcome was the magnitude of change for the 17 items on the PTSD Checklist-Military (PCL-M), which was administered the week before SGB, 1 week after SGB, and 2 to 4 months later. Mean PCL-M score decreased from 49 at baseline to 32, 1 week after the procedure (p < 0.001). 2 to 4 months after SGB, patients maintained an average PCL-M of 32. Patients reported greatest improvement in the first week after SGB for the following symptoms: irritability or angry outbursts, difficulty concentrating, and sleep disturbance. 2 to 4 months later, patients reported greatest improvement in the following: feeling distant or cut off, feeling emotionally numb, irritability or angry outbursts, and difficulty concentrating. SGB is a safe procedure that may provide extended relief for all clusters of PTSD symptoms. As a result of the significant reduction in hyperarousal and avoidance symptoms observed, this study supports incorporation of SGB into PTSD treatment plans.

Relationship of combat experiences and alcohol misuse among U.S. Special Operations Soldiers.

This study examined the association between specific combat experiences and postdeployment hazardous drinking patterns on selected military populations that are considered high risk, such as personnel belonging to U.S. Army Special Operations Forces. Data collection were conducted in a 5-year span in which 1,323 Special Operations Forces Soldiers were surveyed anonymously from 3 to 6 months after returning from deployment to Iraq/Afghanistan regarding their combat experiences and mental health. Combat items were independently analyzed and placed into the following categories: (1) Fighting, (2) Killing, (3) Threat to oneself, (4) Death/Injury of others, and (5) Atrocities. Alcohol misuse was measured using the Alcohol Use Disorders Identification Test-Consumption. Of the Soldiers sampled, 15% (N = 201) screened positive for alcohol misuse 3 to 6 months postdeployment. Combat experiences relating to fighting, threat to oneself, and atrocities were significantly related to alcohol misuse when analyzed individually. However, when factors were analyzed simultaneously, combat experiences in the fighting category were significantly associated with a positive screen for alcohol misuse. In conclusion, Soldiers belonging to certain elite combat units are significantly more likely to screen positive for alcohol misuse if they are exposed to specific types of fighting combat experiences versus any other type of combat exposure.

Challenges presenting in transference and countertransference in the psychodynamic psychotherapy of a military service member.

Complicating the management of the transference-countertransference set for the military psychiatrist is the dilemma of dual agency. This can be a hidden force in the work of most psychiatrists but it is continuous in the field of military health care. The military clinician must candidly engage with this dilemma as it is intrinsic to the mission, "to conserve the fighting strength." In the conduct of a dynamic psychotherapy, the military psychiatrist must craft ways simultaneously to attain both the needs and interests of the individual patient and those of the organization of which he or she is a member. Presented in this article is a case in which the dual agency dilemma manifested itself between the patient and military therapist within the transference-countertransference set. The discussion will center around (a) how this ubiquitous dilemma may present and affect the progress of a psychotherapy, and (b) interventions that will help resolve the conflict. Time honored psychoanalytic principles guiding these interventions include maintenance of therapeutic neutrality, recognition of the therapist's bright and blind spots, and awareness of patterns in the patient's current and past relationships.

Clinically significant proteinuria following the administration of sirolimus to renal transplant recipients.

BACKGROUND: Sirolimus is the latest immunosuppressive agent used to prevent rejection, and may have less nephrotoxicity than calcineurin inhibitor (CNI)-based regimens. To date there has been little documentation of clinically significant proteinuria linked with the use of sirolimus. We have encountered several patients who developed substantial proteinuria associated with sirolimus use. In each patient, the close temporal association between the commencement of sirolimus therapy and proteinuria implicated sirolimus as the most likely etiology of the proteinuria. METHODS: We analyzed the clinical and laboratory information available for all 119 patients transplanted at the Washington Hospital Center between 1999-2003 for whom sirolimus was a component of their immunosuppressant regimen. In these patients, the magnitude of proteinuria was assessed on morning urine samples by turbidometric measurement or random urine protein:creatinine ratios, an estimate of grams of proteinuria/day. Laboratory results were compared between prior, during and following sirolimus use. RESULTS: Twenty-eight patients (24%) developed increased proteinuria from baseline during their post-transplantation course. In 21 patients an alternative cause of proteinuria was either obvious or insufficient data was available to be conclusive. In 7 of the 28 patients there was a striking temporal association between the initiation of sirolimus and the development of nephrotic-range proteinuria. Proteinuria correlated most strongly with sirolimus therapy when compared to other demographic and clinical variables. In most patients, discontinuation of sirolimus resulted in a decrease, but not resolution, of proteinuria. CONCLUSIONS: Sirolimus induces or aggravates pre-existing proteinuria in an unpredictable subset of renal allograft recipients. Proteinuria may improve, but does not resolve, when sirolimus is withdrawn.